大剂量地塞米松对成人原发免疫性血小板减少症患者外周血调节性T细胞的影响及其临床疗效  

Effect of high-dose dexamethasone on peripheral blood regulatory T cells in adult patients with primary immune thrombocytopenia and its clinical efficacy

作　　者：王莉华[1] 张媛[1] 郭燕[1] 字友梅[1] 王秀峰 刘宪凯 黄琰[1] WANG Lihua;ZHANG Yuan;GUO Yan;ZI Youmei;WANG Xiufeng;LIU Xiankai;HUANG Yan(Department of Hematology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院血液科,河南卫辉453100

出　　处：《新乡医学院学报》2023年第8期749-753,758,共6页Journal of Xinxiang Medical University

基　　金：新乡医学院第一附属医院青年培育基金(编号:QN-2019-B14)。

摘　　要：目的探讨大剂量地塞米松对成人原发免疫性血小板减少症(ITP)患者调节性T细胞(Treg)的影响及其临床疗效。方法选择2020年7月至2021年12月新乡医学院第一附属医院收治的120例ITP患者为研究对象。根据治疗方法将患者分为对照组和观察组,每组60例。对照组患者给予醋酸泼尼松片,每日l.0~1.5 mg·kg^(-1),分3次口服,连续服用3周;观察组患者给予醋酸地塞米松片口服,每次20 mg,每日早晚各1次,持续服用4 d,然后停药1周,再重复1个疗程,共治疗2个疗程。对照组中8例因疗效欠佳、症状恶化等原因退出,观察组中4例因疗效欠佳等原因退出。分别于治疗1周时、治疗结束时、治疗后2周,根据患者的血小板和临床表现评估临床疗效,依据临床疗效将患者分为完全缓解组、显效组和无效组;分别于治疗后1、2个月,根据患者的血小板和临床表现评估复发情况;分别于治疗前后采集2组患者晨起空腹静脉血3~5 mL,使用流式细胞仪检测ITP患者外周血CD4^(+)CD25^(+)Treg细胞亚群水平;采用受试者操作特征(ROC)曲线评估CD4^(+)CD25^(+)Treg细胞亚群水平对成人ITP患者预后的预测价值。结果治疗1周时、治疗结束时及治疗后2周,对照组患者的有效率分别为40.4%(21/52)、55.8%(29/52)、71.2%(37/52),观察组患者的有效率分别为60.7%(34/56)、76.8%(43/56)、82.1%(46/56);治疗1周时及治疗结束时,观察组患者的有效率显著高于对照组(χ^(2)=4.459、5.359,P<0.05);治疗后2周,观察组与对照组患者的有效率比较差异无统计学意义(χ^(2)=1.830,P>0.05)。治疗后1、2个月时,对照组患者的复发率分别为26.9%(14/52)、48.1%(25/52),观察组患者的复发率分别为16.1%(9/56)、21.4%(12/56);治疗后1个月时,观察组与对照组患者的复发率比较差异无统计学意义(χ^(2)=1.894,P>0.05);治疗后2个月时,观察组患者的复发率显著低于对照组(χ^(2)=8.502,P<0.05)。治疗前,观察组与对照组患Objective To investigate the effect of high-dose dexamethasone on regulatory T cells(Treg)in adult patients with primary immune thrombocytopenia(ITP)and its clinical efficacy.Methods One hundred and twenty patients with ITP admitted to the First Affiliated Hospital of Xinxiang Medical University from July 2020 to December 2021 were selected as study subjects.According to the treatment method,the patients were divided into the control group and the observation group,with 60 cases in each group.The patients in the control group were given prednisone acetate tablets at a daily dose of 1.0-1.5 mg·kg^(-1)in 3 oral doses for 3 weeks;the patients in the observation group were given dexamethasone acetate tablets orally at 20 mg once in the morning and once in the evening for 4 days,then treatment was stopped for 1 week,and the treatment was repeated for 1 course of treatment,the treatment was performed for a total of 2 courses.In the control group,8 patients withdrew due to poor efficacy and worsening symptoms;4 patients in the observation group withdrew due to poor efficacy and other reasons.The clinical efficacy was evaluated according to the patients′platelets and clinical performance at 1 week of treatment,the end of treatment,2 weeks after treatment,respectively;and the patients were divided into complete remission group,apparent effect group and ineffective group according to clinical efficacy;at 1 and 2 months after treatment,the recurrence was evaluated based on the patient′s platelets and clinical manifestations.Before and after treatment,3-5 mL of fasting venous blood was collected from of patients in the morning in the two groups,the levels of CD4^(+)CD25^(+)Treg cell subpopulations in peripheral blood of ITP patients was detected by flow cytometry.The predictive value of CD4^(+)CD25^(+)Treg cell subpopulations levels on the prognosis of adult ITP patients was evaluated by receiver operating characteristic(ROC)curves.Results At 1 week of treatment,the end of treatment and 2 weeks after treatment,the effec

关 键 词：大剂量地塞米松 原发免疫性血小板减少症 调节性T细胞 

分 类 号：R558[医药卫生—血液循环系统疾病]